Developing the hypoglycemia-nursing early warning score system (Hy-NEWSS): A pilot study

  • Ahmad Hasyim Wibisono | School of Nursing, Faculty of Medicine, Universitas Brawijaya, Indonesia.
  • Dennti Kurniasih Nursing Department, RSUD Abdul Moeloek, Lampung, Indonesia.
  • Eti Sumartiyah Nursing Department, RSUPN Dr Cipto Mangunkusumo, Jakarta, Indonesia.
  • Rima Novia Putri Nursing Department, State Health Polytechnic, Tanjung Pinang, Indonesia.
  • Dikha Ayu Kurnia Faculty of Nursing, University of Indonesia, Depok, Indonesia.
  • Yunisar Gultom Nursing Department, RSUPN Dr Cipto Mangunkusumo, Jakarta, Indonesia.
  • Debie Dahlia Faculty of Nursing, University of Indonesia, Depok, Indonesia.


Background: Severe hypoglycemia occurs in 6% of type 2 DM patients with a 6 to 7% mortality rate. Amidst the COVID-19 pandemic, there has been a higher rate of fatality among diabetes patients, at least 22% of COVID-19 deaths in Wuhan, China. Furthermore, the condition impairs physiological defense against recurrent hypoglycemia in the future. Accordingly, the innovation in this study aims to prevent severe hypoglycemia among type 2 patients through early risk screening, the use of preventative protocols, and patient and family empowerment. This intervention bundle is called Hypoglycemia-Nursing Early Warning Score System (Hy-NEWSS).
Design and Methods: The innovation was implemented in inpatient and outpatient settings, within two weeks with the following sequence: i) internal training, ii) Hy-NEWSS implementation, iii) outcomes evaluation.
Results: Of the twenty-eight patients involved in the study, 3 patients (19%) had a high risk of hypoglycemia, while the remaining had a low risk for the condition. However, at the end of the study there was no event of severe hypoglycemia (0%), and only 1 event (6.33%) of mild hypoglycemia. The results also showed that the accuracy of nurses in implementing the protocols was 93% and that during the evaluation, 95.62% of the responses of the nurses from the inpatient and outpatient settings were positive. Finally, the scores of the sensitivity and specificity evaluation were 99% and 88%, respectively.
Conclusion: It may be concluded from this initial study that Hy-NEWSS is effective in preventing severe hypoglycemia, accurate in identifying patient risk level for the condition, and has high applicability to be implemented in hospital settings.



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Edridge CL, Dunkley AJ, Bodicoat DH, et al. Prevalence and incidence of hypoglycaemia in 532, 542 people with type 2 diabetes on oral therapies and insulin: A systematic review and meta-analysis of population based studies. PLoS One 2015;10:e0126427. DOI:

Fauci S, Kasper D, Hauser S, et al. Harrison’s principles of internal medicine. 19th ed. Michigan: McGraw-Hill Education; 2014.

Clayton D, Woo V, Yale JF. Hypoglycemia. Can J Diabetes 2013;37:S69–71. DOI:

Hussain A, Bhowmik B, do Vale Moreira NC. COVID-19 and diabetes: Knowledge in progress. Diabetes Res Clin Pract 2020;162:.108142. DOI:

Cho NH, Shaw JE, Karuranga S, et al. IDF diabetes atlas: Global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract 2018;138:271–81. DOI:

Olveira G, Abuín J, López R, et al. Risk factors for hypoglycemia in inpatients with total parenteral nutrition and type 2 diabetes: A post hoc analysis of the InSUPAR study. Endocr Pract 2020;26:604–11. DOI:

Angelidi AM, Belanger MJ, Mantzoros CS. COVID-19 and diabetes mellitus: What we know, how our patients should be treated now, and what should happen next. Metabolism 2020;107:154245. DOI:

Karter AJ, Warton EM, Lipska KJ, et al. Development and validation of a tool to identify patients with type 2 diabetes at high risk of hypoglycemia-related emergency department or hospital use. JAMA Intern Med 2017;177:1461–70. DOI:

Han K, Yun JS, Park YM, et al. Development and validation of a risk prediction model for severe hypoglycemia in adult patients with type 2 diabetes: A nationwide population-based cohort study. Clin Epidemiol 2018;10:1545–59. DOI:

American Diabetes Association [Internet]. Hypoglycemia (low blood glucose). American Diabetes Association. 2020 [cited 2020 Oct 1]. Available from:

Rudianto AD. [Konsensus Pengelolaan dan Pencegahan Diabetes Melitus Tipe 2 di Indonesia 2015].[Book in Indonesian]. Jakarta: Indonesian Society of Endocrinology; 2015.

Seaquist ER, Anderson J, Childs B, et al. Hypoglycemia and diabetes: A report of a workgroup of the American Diabetes Association and the Endocrine Society. Diabetes Care 2013;36:1384–95. DOI:

Riddle M. Updates to the standards of medical care in diabetes-2018. Diabetes Care 2018;41:2045–7. DOI:

Evert AB. Treatment of mild hypoglycemia. Diabetes Spectr 2014;27:58–62. DOI:

International Diabetes Federation. Global guideline for type 2 diabetes. Brussels: International Diabetes Federation; 2012.

Wibisono AH, Lestari AN, Sorensen L, et al. Fear of injections among people with type 2 diabetes: Overview of the problem. J Diabetes Nurs 2017;21:91–5.

Coyle ME, Francis K, Chapman Y. Self-management activities in diabetes care: A systematic review. Aust Heal Rev 2013;37:513–22. DOI:

Royal Australian College of General Practitioner. Chronic condition self-management guidelines summary for nurses and allied health professionals. Sydney: Royal Australian College of General Practitioner; 2015.

LaManna J, Litchman ML, Dickinson JK, et al. Diabetes education impact on hypoglycemia outcomes: A systematic review of evidence and gaps in the literature. Diabetes Educ 2019;45:349–69. DOI:

Kavuran E, Yurttas A. Effects of education based on Roy adaptation model on diabetes care profile of patients with type 2 diabetes. Iran Red Crescent Med J 2018;20:e64635. DOI:

Herdman T, Kamitsuru S. Nursing diagnoses definitions and classification 2018–2020. 11th ed. New York: Thieme Publishers; 2018. DOI:

Bulechek G, Butcher H, Dochterman J, et al. Nursing interventions classification. 6th ed. St. Louis: Elsevier Mosby; 2013.

Aligood M. Nursing theorists and their work. Maryland Heights: Elsevier Mosby; 2014.

Roy S, Andrews H. The Roy adaptation model. Norwalk: Appleton & Lange; 2009. DOI:

International Diabetes Federation. Global diabetes plan 2011-2021. Brussels: International Diabetes Federation; 2011.

Ethics Approval
This study was approved by the Health Research Ethics Committee of the Faculty of Nursing, University of Indonesia
Severe hypoglycemia, early screening, preventative protocols, patient empowerment
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How to Cite
Wibisono, A. H., Kurniasih, D., Sumartiyah, E., Putri, R. N., Kurnia, D. A., Gultom, Y., & Dahlia, D. (2021). Developing the hypoglycemia-nursing early warning score system (Hy-NEWSS): A pilot study. Journal of Public Health Research, 10(2).